Provider Demographics
NPI:1609581735
Name:POURNARAS, CHRISTINE CORINE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:CORINE
Last Name:POURNARAS
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3998 FAIR RIDGE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-2946
Mailing Address - Country:US
Mailing Address - Phone:703-655-2582
Mailing Address - Fax:
Practice Address - Street 1:3998 FAIR RIDGE DR STE 100
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-2946
Practice Address - Country:US
Practice Address - Phone:703-655-2582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-23
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024186261363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner